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| Section | Objectives |
|---|---|
| Physician Roles (CanMEDS Framework) | - Medical Expert
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NEW QUESTION # 68
A 26-year-old woman, gravida 1, para 0, aborta 0, presents to your office at 10 weeks' gestation to review the results of her antenatal blood work. She tested positive for hepatitis C. Which one of the following is most advisable to share with her regarding the risks to her and her unborn child?
Answer: B
Explanation:
For pregnant women with hepatitis C infection , vertical transmission risk is approximately 5-6% and is higher with high maternal viral load or HIV coinfection. However, MCCQE objectives emphasize that breastfeeding is not contraindicated in mothers with hepatitis C, as HCV is not transmitted through breast milk. Breastfeeding should only be temporarily avoided if there are cracked or bleeding nipples, which could expose the infant to blood.
Termination of pregnancy is not recommended solely due to hepatitis C infection. Pregnancy does not reliably increase viral load in a clinically significant way, and routine antiviral therapy during pregnancy is generally not recommended because current direct-acting antivirals are not yet standard in pregnancy. The infant does not automatically require antiviral treatment; instead, postnatal monitoring with HCV RNA testing and/or antibody testing at the appropriate age is recommended. While chronic hepatitis C increases long-term risk of cirrhosis and hepatocellular carcinoma, this is not an inevitable outcome.
Therefore, reassuring her that breastfeeding is safe is the most appropriate counselling point.
NEW QUESTION # 69
An 88-year-old man is admitted to hospital with an upper gastrointestinal bleed. He is confused on admission, but his sensorium clears with resuscitation and stabilization. The patient lives in his own home with assistance from his children. Work-up shows metastatic gastric carcinoma for which no curative treatment can be offered. The family insists that the patient not be told the diagnosis because they fear he will have a "mental breakdown." Which one of the following is the best next step?
Answer: A
Explanation:
Once the patient's confusion has resolved, he should be presumed capable unless an assessment shows otherwise. MCCQE ethics objectives prioritize patient autonomy, informed decision-making, and confidentiality . Families may request "therapeutic privilege" or nondisclosure, but this is not the default and cannot override a capable patient's right to information needed to make decisions. The appropriate first step is to explore the patient's preferences about receiving serious news (some patients prefer limited information or to delegate decisions). Asking the patient whether he wants to know the diagnosis respects autonomy while remaining sensitive to potential distress. Simply telling him immediately (without checking preferences) may conflict with patient-centered disclosure, and automatically complying with the family's request violates the patient's rights and undermines informed consent for goals-of-care planning. A palliative care consult is appropriate, but only after clarifying the patient's understanding and wishes and beginning honest, preference- guided communication. The clinician should also support the family, explain ethical duties, and reassure them that disclosure can be done gradually and compassionately.
NEW QUESTION # 70
A health authority implements the first-ever colon cancer screening program in its territory. Which one of the following colon cancer indices will likely increase?
Answer: B
Explanation:
When a screening program is introduced, the incidence rate appears to rise because more cases (including subclinical ones) are identified earlier. This is known as "lead-time bias" or "ascertainment bias." Toronto Notes 2023 - Public Health, Screening and Epidemiology:
"Screening increases the apparent incidence of disease as more early or latent cases are detected." MCCQE1 Objectives - Preventive Medicine > Screening:
"Candidates should understand how implementation of screening programs affects disease incidence and epidemiologic metrics." Case fatality rate (A) may decrease. PPV (B) depends on prevalence. Positive biopsy rate (C) may remain stable. Treatment rate (E) could increase, but incidence is the most directly and consistently affected.
NEW QUESTION # 71
You are asked to see a 50-year-old man 2 hours after he underwent a laparotomy for gastric resection. Lab results are as follows:
pH
7.28 (7.35-7.45)
PaCO#
60 mm Hg (35-40)
PaO#
60 mm Hg (85-105) with 4 L/min via nasal prongs
Bicarbonate (HCO#)
24 mmol/L (24-30)
Which one of the following is most consistent with this clinical presentation?
Answer: A
Explanation:
This ABG reveals primary respiratory acidosis (#pH, #PaCO#, normal HCO#), likely from hypoventilation due to postoperative pain, sedation, or narcotics. PaO# is also low, suggesting inadequate oxygenation.
Toronto Notes 2023 - Respiratory, "Postoperative Respiratory Complications":
"Postoperative respiratory acidosis results from hypoventilation, often due to pain, sedatives, or poor respiratory effort. Assess airway, breathing, and support oxygenation." MCCQE1 Objectives (Internal Medicine > 44-3: Acid-Base Disturbances):
"Candidates must recognize respiratory acidosis on ABG and relate findings to common postoperative complications." Metabolic acidosis (C) would show #HCO#. Compensated alkalosis (D) would show opposite ABG changes.
Hypermetabolic states increase respiratory drive, not decrease it.
NEW QUESTION # 72
A 39-year-old woman comes to the office for a periodic health examination. She reports that her father had a recent diagnosis of breast cancer (at age 62 years) and that a paternal aunt had ovarian cancer in her early 40s.
The results of mammography are normal. Which one of the following is the most appropriate recommendation for this patient?
Answer: C
Explanation:
This patient has a family history of both male breast cancer (father) and early-onset ovarian cancer (aunt), which are red flags for BRCA1/2 mutations. Genetic counseling and BRCA testing are the appropriate next steps to stratify cancer risk and guide screening and prevention.
Toronto Notes 2023 - Oncology, "Breast Cancer Risk" Section:
"BRCA testing is recommended for individuals with a strong family history of breast or ovarian cancer, particularly if involving male relatives or early-onset cases." MCCQE1 Objectives (Population Health > 97-5: Screening and Prevention):
"Candidates must identify high-risk individuals who require genetic counseling and screening beyond population guidelines." Tamoxifen (A) and prophylactic mastectomy (E) are only considered after confirming mutation status. Annual screening starting at 50 (D) is for average-risk women. Fine-needle sampling (C) is not a screening tool.
NEW QUESTION # 73
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